Systematic Aortic and Pelvic Lymphadenectomy Versus Resection of Bulky Nodes Only in Optimally Debulked Advanced Ovarian Cancer: A Randomized Clinical Trial
Identifieur interne : 008132 ( Main/Exploration ); précédent : 008131; suivant : 008133Systematic Aortic and Pelvic Lymphadenectomy Versus Resection of Bulky Nodes Only in Optimally Debulked Advanced Ovarian Cancer: A Randomized Clinical Trial
Auteurs : Pierluigi Benedetti Panici ; Angelo Maggioni ; Neville Hacker ; Fabio Landoni ; Sven Ackermann ; Elio Campagnutta ; Karl Tamussino ; Raimund Winter ; Antonio Pellegrino ; Stefano Greggi ; Roberto Angioli ; Natalina Manci ; Giovanni Scambia ; Tiziana Dell'Anna ; Roldano Fossati ; Irene Floriani ; Rita S. Rossi ; Roberto Grassi ; Giuseppe Favalli ; Francesco Raspagliesi ; Diana Giannarelli ; Luca Martella ; Costantino MangioniSource :
- Journal of the National Cancer Institute [ 0027-8874 ] ; 2005-04-20.
Abstract
Background: The role of systematic aortic and pelvic lymphadenectomy in patients with optimally debulked advanced ovarian cancer is unclear and has not been addressed by randomized studies. We conducted a randomized clinical trial to determine whether systematic aortic and pelvic lymphadenectomy improves progression-free and overall survival compared with resection of bulky nodes only. Methods: From January 1991 through May 2003, 427 eligible patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIB-C and IV epithelial ovarian carcinoma were randomly assigned to undergo systematic pelvic and para-aortic lymphadenectomy (n = 216) or resection of bulky nodes only (n = 211). Progression-free survival and overall survival were analyzed using a log-rank statistic and a Cox multivariable regression analysis. All statistical tests were two-sided. Results: After a median follow-up of 68.4 months, 292 events (i.e., recurrences or deaths) were observed, and 202 patients had died. Sites of first recurrences were similar in both arms. The adjusted risk for first event was statistically significantly lower in the systematic lymphadenectomy arm (hazard ratio [HR] = .75, 95% confidence interval [CI] = 0.59 to 0.94; P = .01) than in the no-lymphadenectomy arm, corresponding to 5-year progression-free survival rates of 31.2 and 21.6% in the systematic lymphadenectomy and control arms, respectively (difference = 9.6%, 95% CI = 1.5% to 21.6%), and to median progression-free survival of 29.4 and 22.4 months, respectively (difference = 7 months, 95% CI = 1.0 to 14.4 months). The risk of death was similar in both arms (HR = 0.97, 95% CI = 0.74 to 1.29; P = .85), corresponding to 5-year overall survival rates of 48.5 and 47%, respectively (difference = 1.5%, 95% CI = −8.4% to 10.6%), and to median overall survival of 58.7 and 56.3 months, respectively (difference = 2.4 months, 95% CI = −11.8 to 21.0 months). Median operating time was longer, and the percentage of patients requiring blood transfusions was higher in the systematic lymphadenectomy arm than in the no-lymphadenectomy arm (300 versus 210 minutes, P<.001, and 72% versus 59%; P = .006, respectively). Conclusion: Systematic lymphadenectomy improves progression-free but not overall survival in women with optimally debulked advanced ovarian carcinoma.
Url:
DOI: 10.1093/jnci/dji102
Affiliations:
Links toward previous steps (curation, corpus...)
- to stream Istex, to step Corpus: 006E77
- to stream Istex, to step Curation: 006E77
- to stream Istex, to step Checkpoint: 001908
- to stream Main, to step Merge: 008355
- to stream Main, to step Curation: 008132
Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Systematic Aortic and Pelvic Lymphadenectomy Versus Resection of Bulky Nodes Only in Optimally Debulked Advanced Ovarian Cancer: A Randomized Clinical Trial</title><author><name sortKey="Panici, Pierluigi Benedetti" sort="Panici, Pierluigi Benedetti" uniqKey="Panici P" first="Pierluigi Benedetti" last="Panici">Pierluigi Benedetti Panici</name></author><author><name sortKey="Maggioni, Angelo" sort="Maggioni, Angelo" uniqKey="Maggioni A" first="Angelo" last="Maggioni">Angelo Maggioni</name></author><author><name sortKey="Hacker, Neville" sort="Hacker, Neville" uniqKey="Hacker N" first="Neville" last="Hacker">Neville Hacker</name></author><author><name sortKey="Landoni, Fabio" sort="Landoni, Fabio" uniqKey="Landoni F" first="Fabio" last="Landoni">Fabio Landoni</name></author><author><name sortKey="Ackermann, Sven" sort="Ackermann, Sven" uniqKey="Ackermann S" first="Sven" last="Ackermann">Sven Ackermann</name></author><author><name sortKey="Campagnutta, Elio" sort="Campagnutta, Elio" uniqKey="Campagnutta E" first="Elio" last="Campagnutta">Elio Campagnutta</name></author><author><name sortKey="Tamussino, Karl" sort="Tamussino, Karl" uniqKey="Tamussino K" first="Karl" last="Tamussino">Karl Tamussino</name></author><author><name sortKey="Winter, Raimund" sort="Winter, Raimund" uniqKey="Winter R" first="Raimund" last="Winter">Raimund Winter</name></author><author><name sortKey="Pellegrino, Antonio" sort="Pellegrino, Antonio" uniqKey="Pellegrino A" first="Antonio" last="Pellegrino">Antonio Pellegrino</name></author><author><name sortKey="Greggi, Stefano" sort="Greggi, Stefano" uniqKey="Greggi S" first="Stefano" last="Greggi">Stefano Greggi</name></author><author><name sortKey="Angioli, Roberto" sort="Angioli, Roberto" uniqKey="Angioli R" first="Roberto" last="Angioli">Roberto Angioli</name></author><author><name sortKey="Manci, Natalina" sort="Manci, Natalina" uniqKey="Manci N" first="Natalina" last="Manci">Natalina Manci</name></author><author><name sortKey="Scambia, Giovanni" sort="Scambia, Giovanni" uniqKey="Scambia G" first="Giovanni" last="Scambia">Giovanni Scambia</name></author><author><name sortKey="Dell Anna, Tiziana" sort="Dell Anna, Tiziana" uniqKey="Dell Anna T" first="Tiziana" last="Dell'Anna">Tiziana Dell'Anna</name></author><author><name sortKey="Fossati, Roldano" sort="Fossati, Roldano" uniqKey="Fossati R" first="Roldano" last="Fossati">Roldano Fossati</name></author><author><name sortKey="Floriani, Irene" sort="Floriani, Irene" uniqKey="Floriani I" first="Irene" last="Floriani">Irene Floriani</name></author><author><name sortKey="Rossi, Rita S" sort="Rossi, Rita S" uniqKey="Rossi R" first="Rita S." last="Rossi">Rita S. Rossi</name></author><author><name sortKey="Grassi, Roberto" sort="Grassi, Roberto" uniqKey="Grassi R" first="Roberto" last="Grassi">Roberto Grassi</name></author><author><name sortKey="Favalli, Giuseppe" sort="Favalli, Giuseppe" uniqKey="Favalli G" first="Giuseppe" last="Favalli">Giuseppe Favalli</name></author><author><name sortKey="Raspagliesi, Francesco" sort="Raspagliesi, Francesco" uniqKey="Raspagliesi F" first="Francesco" last="Raspagliesi">Francesco Raspagliesi</name></author><author><name sortKey="Giannarelli, Diana" sort="Giannarelli, Diana" uniqKey="Giannarelli D" first="Diana" last="Giannarelli">Diana Giannarelli</name></author><author><name sortKey="Martella, Luca" sort="Martella, Luca" uniqKey="Martella L" first="Luca" last="Martella">Luca Martella</name></author><author><name sortKey="Mangioni, Costantino" sort="Mangioni, Costantino" uniqKey="Mangioni C" first="Costantino" last="Mangioni">Costantino Mangioni</name></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:EC2B1E7693E1F1FAD9AC2ADA520289F418BD1955</idno><date when="2005" year="2005">2005</date><idno type="doi">10.1093/jnci/dji102</idno><idno type="url">https://api.istex.fr/document/EC2B1E7693E1F1FAD9AC2ADA520289F418BD1955/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">006E77</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">006E77</idno><idno type="wicri:Area/Istex/Curation">006E77</idno><idno type="wicri:Area/Istex/Checkpoint">001908</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Checkpoint">001908</idno><idno type="wicri:doubleKey">0027-8874:2005:Panici P:systematic:aortic:and</idno><idno type="wicri:Area/Main/Merge">008355</idno><idno type="wicri:Area/Main/Curation">008132</idno><idno type="wicri:Area/Main/Exploration">008132</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Systematic Aortic and Pelvic Lymphadenectomy Versus Resection of Bulky Nodes Only in Optimally Debulked Advanced Ovarian Cancer: A Randomized Clinical Trial</title><author><name sortKey="Panici, Pierluigi Benedetti" sort="Panici, Pierluigi Benedetti" uniqKey="Panici P" first="Pierluigi Benedetti" last="Panici">Pierluigi Benedetti Panici</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Maggioni, Angelo" sort="Maggioni, Angelo" uniqKey="Maggioni A" first="Angelo" last="Maggioni">Angelo Maggioni</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Hacker, Neville" sort="Hacker, Neville" uniqKey="Hacker N" first="Neville" last="Hacker">Neville Hacker</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Landoni, Fabio" sort="Landoni, Fabio" uniqKey="Landoni F" first="Fabio" last="Landoni">Fabio Landoni</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Ackermann, Sven" sort="Ackermann, Sven" uniqKey="Ackermann S" first="Sven" last="Ackermann">Sven Ackermann</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Campagnutta, Elio" sort="Campagnutta, Elio" uniqKey="Campagnutta E" first="Elio" last="Campagnutta">Elio Campagnutta</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Tamussino, Karl" sort="Tamussino, Karl" uniqKey="Tamussino K" first="Karl" last="Tamussino">Karl Tamussino</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Winter, Raimund" sort="Winter, Raimund" uniqKey="Winter R" first="Raimund" last="Winter">Raimund Winter</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Pellegrino, Antonio" sort="Pellegrino, Antonio" uniqKey="Pellegrino A" first="Antonio" last="Pellegrino">Antonio Pellegrino</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Greggi, Stefano" sort="Greggi, Stefano" uniqKey="Greggi S" first="Stefano" last="Greggi">Stefano Greggi</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Angioli, Roberto" sort="Angioli, Roberto" uniqKey="Angioli R" first="Roberto" last="Angioli">Roberto Angioli</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Manci, Natalina" sort="Manci, Natalina" uniqKey="Manci N" first="Natalina" last="Manci">Natalina Manci</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Scambia, Giovanni" sort="Scambia, Giovanni" uniqKey="Scambia G" first="Giovanni" last="Scambia">Giovanni Scambia</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Dell Anna, Tiziana" sort="Dell Anna, Tiziana" uniqKey="Dell Anna T" first="Tiziana" last="Dell'Anna">Tiziana Dell'Anna</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Fossati, Roldano" sort="Fossati, Roldano" uniqKey="Fossati R" first="Roldano" last="Fossati">Roldano Fossati</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Floriani, Irene" sort="Floriani, Irene" uniqKey="Floriani I" first="Irene" last="Floriani">Irene Floriani</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Rossi, Rita S" sort="Rossi, Rita S" uniqKey="Rossi R" first="Rita S." last="Rossi">Rita S. Rossi</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Grassi, Roberto" sort="Grassi, Roberto" uniqKey="Grassi R" first="Roberto" last="Grassi">Roberto Grassi</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Favalli, Giuseppe" sort="Favalli, Giuseppe" uniqKey="Favalli G" first="Giuseppe" last="Favalli">Giuseppe Favalli</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Raspagliesi, Francesco" sort="Raspagliesi, Francesco" uniqKey="Raspagliesi F" first="Francesco" last="Raspagliesi">Francesco Raspagliesi</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Giannarelli, Diana" sort="Giannarelli, Diana" uniqKey="Giannarelli D" first="Diana" last="Giannarelli">Diana Giannarelli</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Martella, Luca" sort="Martella, Luca" uniqKey="Martella L" first="Luca" last="Martella">Luca Martella</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author><author><name sortKey="Mangioni, Costantino" sort="Mangioni, Costantino" uniqKey="Mangioni C" first="Costantino" last="Mangioni">Costantino Mangioni</name><affiliation><wicri:noCountry code="subField">(DG)</wicri:noCountry></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of the National Cancer Institute</title><title level="j" type="abbrev">JNCI J Natl Cancer Inst</title><idno type="ISSN">0027-8874</idno><idno type="eISSN">1460-2105</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2005-04-20">2005-04-20</date><biblScope unit="volume">97</biblScope><biblScope unit="issue">8</biblScope><biblScope unit="page" from="560">560</biblScope><biblScope unit="page" to="566">566</biblScope></imprint><idno type="ISSN">0027-8874</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0027-8874</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: The role of systematic aortic and pelvic lymphadenectomy in patients with optimally debulked advanced ovarian cancer is unclear and has not been addressed by randomized studies. We conducted a randomized clinical trial to determine whether systematic aortic and pelvic lymphadenectomy improves progression-free and overall survival compared with resection of bulky nodes only. Methods: From January 1991 through May 2003, 427 eligible patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIB-C and IV epithelial ovarian carcinoma were randomly assigned to undergo systematic pelvic and para-aortic lymphadenectomy (n = 216) or resection of bulky nodes only (n = 211). Progression-free survival and overall survival were analyzed using a log-rank statistic and a Cox multivariable regression analysis. All statistical tests were two-sided. Results: After a median follow-up of 68.4 months, 292 events (i.e., recurrences or deaths) were observed, and 202 patients had died. Sites of first recurrences were similar in both arms. The adjusted risk for first event was statistically significantly lower in the systematic lymphadenectomy arm (hazard ratio [HR] = .75, 95% confidence interval [CI] = 0.59 to 0.94; P = .01) than in the no-lymphadenectomy arm, corresponding to 5-year progression-free survival rates of 31.2 and 21.6% in the systematic lymphadenectomy and control arms, respectively (difference = 9.6%, 95% CI = 1.5% to 21.6%), and to median progression-free survival of 29.4 and 22.4 months, respectively (difference = 7 months, 95% CI = 1.0 to 14.4 months). The risk of death was similar in both arms (HR = 0.97, 95% CI = 0.74 to 1.29; P = .85), corresponding to 5-year overall survival rates of 48.5 and 47%, respectively (difference = 1.5%, 95% CI = −8.4% to 10.6%), and to median overall survival of 58.7 and 56.3 months, respectively (difference = 2.4 months, 95% CI = −11.8 to 21.0 months). Median operating time was longer, and the percentage of patients requiring blood transfusions was higher in the systematic lymphadenectomy arm than in the no-lymphadenectomy arm (300 versus 210 minutes, P<.001, and 72% versus 59%; P = .006, respectively). Conclusion: Systematic lymphadenectomy improves progression-free but not overall survival in women with optimally debulked advanced ovarian carcinoma.</div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Ackermann, Sven" sort="Ackermann, Sven" uniqKey="Ackermann S" first="Sven" last="Ackermann">Sven Ackermann</name><name sortKey="Angioli, Roberto" sort="Angioli, Roberto" uniqKey="Angioli R" first="Roberto" last="Angioli">Roberto Angioli</name><name sortKey="Campagnutta, Elio" sort="Campagnutta, Elio" uniqKey="Campagnutta E" first="Elio" last="Campagnutta">Elio Campagnutta</name><name sortKey="Dell Anna, Tiziana" sort="Dell Anna, Tiziana" uniqKey="Dell Anna T" first="Tiziana" last="Dell'Anna">Tiziana Dell'Anna</name><name sortKey="Favalli, Giuseppe" sort="Favalli, Giuseppe" uniqKey="Favalli G" first="Giuseppe" last="Favalli">Giuseppe Favalli</name><name sortKey="Floriani, Irene" sort="Floriani, Irene" uniqKey="Floriani I" first="Irene" last="Floriani">Irene Floriani</name><name sortKey="Fossati, Roldano" sort="Fossati, Roldano" uniqKey="Fossati R" first="Roldano" last="Fossati">Roldano Fossati</name><name sortKey="Giannarelli, Diana" sort="Giannarelli, Diana" uniqKey="Giannarelli D" first="Diana" last="Giannarelli">Diana Giannarelli</name><name sortKey="Grassi, Roberto" sort="Grassi, Roberto" uniqKey="Grassi R" first="Roberto" last="Grassi">Roberto Grassi</name><name sortKey="Greggi, Stefano" sort="Greggi, Stefano" uniqKey="Greggi S" first="Stefano" last="Greggi">Stefano Greggi</name><name sortKey="Hacker, Neville" sort="Hacker, Neville" uniqKey="Hacker N" first="Neville" last="Hacker">Neville Hacker</name><name sortKey="Landoni, Fabio" sort="Landoni, Fabio" uniqKey="Landoni F" first="Fabio" last="Landoni">Fabio Landoni</name><name sortKey="Maggioni, Angelo" sort="Maggioni, Angelo" uniqKey="Maggioni A" first="Angelo" last="Maggioni">Angelo Maggioni</name><name sortKey="Manci, Natalina" sort="Manci, Natalina" uniqKey="Manci N" first="Natalina" last="Manci">Natalina Manci</name><name sortKey="Mangioni, Costantino" sort="Mangioni, Costantino" uniqKey="Mangioni C" first="Costantino" last="Mangioni">Costantino Mangioni</name><name sortKey="Martella, Luca" sort="Martella, Luca" uniqKey="Martella L" first="Luca" last="Martella">Luca Martella</name><name sortKey="Panici, Pierluigi Benedetti" sort="Panici, Pierluigi Benedetti" uniqKey="Panici P" first="Pierluigi Benedetti" last="Panici">Pierluigi Benedetti Panici</name><name sortKey="Pellegrino, Antonio" sort="Pellegrino, Antonio" uniqKey="Pellegrino A" first="Antonio" last="Pellegrino">Antonio Pellegrino</name><name sortKey="Raspagliesi, Francesco" sort="Raspagliesi, Francesco" uniqKey="Raspagliesi F" first="Francesco" last="Raspagliesi">Francesco Raspagliesi</name><name sortKey="Rossi, Rita S" sort="Rossi, Rita S" uniqKey="Rossi R" first="Rita S." last="Rossi">Rita S. Rossi</name><name sortKey="Scambia, Giovanni" sort="Scambia, Giovanni" uniqKey="Scambia G" first="Giovanni" last="Scambia">Giovanni Scambia</name><name sortKey="Tamussino, Karl" sort="Tamussino, Karl" uniqKey="Tamussino K" first="Karl" last="Tamussino">Karl Tamussino</name><name sortKey="Winter, Raimund" sort="Winter, Raimund" uniqKey="Winter R" first="Raimund" last="Winter">Raimund Winter</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/LymphedemaV1/Data/Main/Exploration
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 008132 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd -nk 008132 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= LymphedemaV1
|flux= Main
|étape= Exploration
|type= RBID
|clé= ISTEX:EC2B1E7693E1F1FAD9AC2ADA520289F418BD1955
|texte= Systematic Aortic and Pelvic Lymphadenectomy Versus Resection of Bulky Nodes Only in Optimally Debulked Advanced Ovarian Cancer: A Randomized Clinical Trial
}}
| This area was generated with Dilib version V0.6.31. |  |